Quality Assuarnce Surveillance Plan Template - U.S. Department of Veterans Affairs

Project QASP Template

Quality Assurance Surveillance Plan

For: Medical Services

Contract Number: Upon award, Government will enter contract number>

Contract Description: < Provided brief contract description (2-3 sentences) of services to be provided.

Contractor’s name: <Enter your company name. (hereafter referred to as the contractor).

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

· What will be monitored.

· How monitoring will take place.

· Who will conduct the monitoring.

· How monitoring efforts and results will be documented.

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

2. Government Roles and Responsibilities

The following personnel shall oversee and coordinate surveillance activities.

a. Contracting Officer (CO) - The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned CO: Upon award, Government will enter name.

Organization or Agency: Department of Veterans Affairs, Office of Acquisition and Materiel Management

b. Contracting Officer’s Technical Representative (COTR) - The COTR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COTR shall keep a quality assurance file. The COTR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

Assigned COTR: <Upon award, Government will enter name.>

c. Other Key Government Personnel - Upon award, Government will enter name, if applicable. This may include Performance Monitors, Clinical Quality experts, etc. who act on behalf of the COTR to monitor performance.>

3. Contractor Representatives

The following employees of the contractor serve as the contractor’s program manager for this contract.

a. Program Manager - Enter name.

b. Other Contractor Personnel - Enter name(s) or delete these lines if not applicable>

Title: <Enter title(s) or delete these lines if not applicable.

4. Performance Standards

Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards.

The Performance Requirements Summary Matrix, paragraph <enter number> in the Performance Work Statement (PWS), includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL).

<Insert the performance standards matrix from the Performance Requirements section in your proposed PWS below. The matrix currently inserted below is a copy of the matrix provided in the PWS Template provided by VA to Offerors. The matrix below should be tailored to your specific technical solution. Performance standards not applicable to your solutions should have been deleted and any additional proposed standards should have been added.

Task / ID / Indicator / Standard / Acceptable Quality Level / Method of Surveillance / Incentive /
Clinical Information Return / 1 / Routine care and routine diagnostic testing: clinical information provided back to the authorizing VA medical center. / Within 30 days of the episode of care or prior to referral for further consultation. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
2 / Inpatient care: clinical information provided back to the authorizing VA medical center. / Within 30 days of patient discharge or prior to referral for further consultation back to the referring VA medical center. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
3 / Urgent outpatient care: clinical information provided back to the authorizing VA medical center. / Within 48 hours or prior to the need for further medical referral by the authorizing VA medical center. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
4 / Urgent diagnostic testing:
verbal and written test results provided to the authorizing VA medical center. / Verbal results: immediately (within 24 hours.)
Written test results: within 24 hours. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
5 / Radiology: Report is electronically signed. / Within 48 hours of study being performed. / 90% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
Access
(for all outpatient services other than dental) / 6 / For all services other than dental, patient must be seen by the provider in a timely manner. / Within 20 minutes of scheduled appointment or sooner. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
7 / For all specialty care services other than dental, patient must be able to schedule an appointment with a specialist in a timely manner. / Within 30 days of receipt of referral/authorization by the provider. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
8 / For all diagnostic services, patient must be able to schedule an appointment for a routine diagnostic test in a timely manner. / Within 30 days of receipt of referral/authorization by the provider. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
Access
(for dental services) / 9 / All dental patients must receive an appointment in a timely manner. / Within 30 days of the patient’s desired appointment date for an initial examination. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
10 / Any treatment identified during the dental patient's initial examination must be initiated in a timely manner. / Within 30 days of the patient’s desired appointment date. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
11 / Patients must receive subsequent treatment in a timely manner. / Within 30 days of the patient’s desired appointment date, based on medical need as determined by the provider. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
Quality Care / 12 / Accreditation of inpatient facilities. / Inpatient facilities must be accredited by one of the following organizations:
• JCAHO
• CARF
• ICAVL
• AOA / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
13 / Provider credentialing. / All providers must be credentialed in accordance with the Project HERO solicitation Section B.4.6. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
Patient Safety / 14 / Patient safety incidents must be reported to the authorizing VA medical center and the COTR. / All incidents reported immediately (within 24 hours.) / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
15 / Patient safety incidents must be investigated, confirmed and resolved. / All incidents are investigated, confirmed and resolved. / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
16 / Patient safety incident investigations, conclusions and findings must be reported to the authorizing VA medical center and the COTR. / Updates and findings of patient safety incident investigations are provided continuously (at least once a week.) / 100% / <Observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
Patient Satisfaction / 17 / Patient complaints about the quality of care are reported to the VISN Patient Advocate, the COTR, and the Contractor Patient for resolution. / All patient complaints are reported immediately (within 24 hours.) / 100% / User survey, observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>
18 / Providers and staff are familiarized with the process outlined in contractor’s grievance procedures as well as patient rights. / All providers and staff are educated. / 100% / User survey, observation and random inspection (auditing) or any other method that was proposed in your solution.> / <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.>

5. Incentives

The Government shall use <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.> as incentives. Incentives shall be based on exceeding, meeting, or not meeting performance standards.

6. Methods of QA Surveillance

Various methods exist to monitor performance. The COTR shall use the surveillance methods listed below in the administration of this QASP.

a. DIRECT OBSERVATION. (Can be performed periodically or through 100% surveillance.)

b. PERIODIC INSPECTION. (Evaluates outcomes on a periodic basis. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.)

c. USER SURVEY. (Combines elements of validated user complaints and random sampling. Random survey is conducted to solicit user satisfaction. May also generate inspections and sampling.)

d. VALIDATED USER/CUSTOMER COMPLAINTS. (Relies on the patient to identify deficiencies. Complaints are then investigated and validated.)

e. 100% INSPECTION. (Evaluates all outcomes.)

Insert performance standard(s) IDs or delete this method.>

f. PERIODIC SAMPLING. (Variation of random sampling. However, sample is only taken when a problem/deficiency is suspected. Sample results are applicable only for the specific work inspected. Since sample is not entirely random, it cannot be applied to total activity performance.)

g. RANDOM SAMPLING. (Designed to evaluate performance by randomly selecting and inspecting a sample of cases.

h. Progress or status meetings.

i. Analysis of contractor's progress reports. (Evaluate cost, schedule, etc.)

8. Ratings

Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

9. DOCUMENTING PERFORMANCE

a. Acceptable Performance

The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

b. Unacceptable performance

When unacceptable performance occurs, the COTR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COTR shall document the discussion and place it in the COTR file.

When the COTR determines formal written communication is required, the COTR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor's program manager.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the COTR. The Government shall review the contractor's corrective action plan to determine acceptability.